Provider Demographics
NPI:1003918822
Name:AVRUSKIN, THEODORE WILFRED (MD)
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:WILFRED
Last Name:AVRUSKIN
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:1 BROOKDALE PLZ
Mailing Address - Street 2:SUITE 222-AARON BUILDING
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-3139
Mailing Address - Country:US
Mailing Address - Phone:718-240-5960
Mailing Address - Fax:718-240-5852
Practice Address - Street 1:1 BROOKDALE PLZ
Practice Address - Street 2:SUITE 222-AARON BUILDING
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-3139
Practice Address - Country:US
Practice Address - Phone:718-240-5960
Practice Address - Fax:718-240-5852
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY105322207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000000080122OtherGHI HMO
NY0090568OtherAETNA
NY1000002953301OtherUNITED CHP/FHP/MEDICAID
NY105322-A41OtherHEALTH FIRST
NY581251OtherEMPIRE BLUE CROSSBLUE SHI
NYKS967OtherOXFORD
NY4C0332OtherHEALTH NET
NY1000016980OtherAFFINITY
NY5398069OtherUS HEALTHCARE
NY00183835Medicaid
NY105322NO2OtherHIP
NY1489777OtherPHCS
NY60N0082OtherNEIGHBORHOOD
NYNY160201OtherWELLCARE
NY0041461OtherGHI
NY100002953303OtherAMERICHOICE
NY343010201OtherHEALTH PLUS
NYA63378Medicare UPIN
NY581251Medicare PIN